'Market-driven' health care is no solution

Updated 11:26 pm, Thursday, July 5, 2012

No surprise: Texas appears to be on everyone's short list of states likely to say no to expanding Medicaid. This is an option, the Supreme Court said when it ruled President Obama's health care law constitutional recently.

And Texas officials indeed signaled some hesitancy to expand. To their credit, however, they have not shuttered the windows and barred the door.

They shouldn't. And the substantial federal dollars on the table shouldn't be the sole determining factor.

This is what else should significantly factor in: How will the state ensure that more Texans are insured? If Texas forgoes Medicaid expansion and its dollars, what will it do alternatively to get this done?

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Texas, you see, has had a thing about providing Medicaid to low-income “able-bodied” adults — a target population of expansion.

If Texas was at full employment and all Texas employers were on board with providing insurance, this might be a salient position to take. But Texas isn't and Texas employers aren't.

The state in any case prefers “market solutions” to government ones.

Which brings to mind those Southern lunch counters. As you recall, they didn't desegregate on their own.

This is not a far-fetched analogy. The right thing to do gets muddled if rights aren't involved and the free market is. And that's really where the sides part on health care — whether it's a right.

I happen to think it is. It is, in any case, the right thing to do, and this is what should drive Texas' solution.

I know; maybe I'm jumping the gun. There is ample precedent for the state spouting “principle” but sucking up federal dollars anyway.

Gov. Rick Perry and others have slammed federal stimulus programs but used such funds to plug state budget shortfalls for 2010-11. And there was $831 million taken last year to keep teachers employed.

A charitable view is that this represents the triumph of pragmatism over ideology. There are uncharitable views.

State Rep. Garnet Coleman of Houston, who's on the House public health committee, is hoping such pragmatism influences the coming Medicaid-expansion debate in the Legislature.

“People are tired of people being hurt by policy disagreements,” he said.

Coleman also notes that expanding Medicaid makes good economic sense. He said that every dollar spent on health care produces three more.

The state claims a history of attempting to insure the uninsured. It cites a 2007 proposal that would have provided premium subsidies to low-income adults, a target population of 2.1 million — legal residents below 200 percent of federal poverty levels.

This didn't win federal approval amid some criticism of it being too limited.

But the state won a waiver in December that will allow hospitals to net more federal dollars while still serving difficult-to-serve segments.

Market-based solutions, in other words.

Right — but still substantially financed with federal dollars. And we're talking big bucks in the case of Medicaid expansion.

The state pays about 40 percent of Medicaid. The Affordable Care Act has the federal government paying the full cost of Medicaid expansion for the first three years. The state's share would rise to and be capped at 10 percent in 2020.

That's a bargain.

So again, Texas: If you refuse Medicaid expansion and its dollars, how will you accomplish broadened coverage?

If “market-driven” means we won't even try — if it means dog eat dog — that, rights aside, falls way short of doing the right thing.